Individual
MR. ALAN HARRIS LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9 OLD ORCHARD RD, BLOOMFIELD, CT 06002-2259
(860) 402-4402
Mailing address
9 OLD ORCHARD RD, BLOOMFIELD, CT 06002-2259
(860) 402-4402
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
000875
CT
1041C0700X
Clinical Social Worker
Primary
000875
CT
Other
Enumeration date
08/31/2006
Last updated
01/14/2014
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